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Northern Ireland has been without a government since the collapse of a coalition in January 2017; one doctor says wryly that, in the two years since, the profession has learnt that the only thing worse than having politicians is not having politicians.

In September, Westminster’s Northern Ireland secretary Karen Bradley cut the pay of the devolved Northern Ireland Assembly’s elected members, in an effort to pressure them to conclude power sharing talks and return to work—but there is still no resolution in sight (see box).

“If doctors failed to turn up for work, they would stop paying us,” says Tom Black, chair of the BMA’s Northern Ireland Council. “If politicians are failing to work at their profession, there should be sanctions.”

Health policy experts, doctors, and other healthcare professionals warn of a “huge hiatus in health” as a result of the power vacuum in Stormont.

Spiralling waiting lists

Waiting lists in Northern Ireland are substantially worse than in the rest of the UK,1 and many blame the lack of ministers.

“Waiting times are appalling,” says Deirdre Heenan, professor of social policy at Ulster University and member of the Council of State in the Republic of Ireland. “If the assembly was sitting and a health minister was being asked every day about these numbers, then eventually he or she would have enough and starting working on a fix. That is not happening.”

Department of Health figures as of September 2018 show 94 222 people in Northern Ireland waiting longer than 52 weeks for their first consultant led outpatient appointment2; equivalent statistics for England show 3464 waiting, from a much larger population.3